[Question #461] Worried.

88 months ago
In June of 2015 I got my first Pap smear and it came back as ASCUS, but no HPV was detected. I got re-tested in December of 2015 and my results were the same- ASCUS, but HPV was not detected. I've been having problems with anal fissures lately so I went to my primary doctor and she thought it was a herpes outbreak. She did a swab culture on my anus for herpes 1 & 2, HPV, Gonnorhea and the rest of STD's. I left the office very upset because she didn't even listen to me. I have not been sexually active in 2 years and got tested for STD's in November, which all came back negative except for hsv 1- but I've had it for years and rarely get outbreaks. She convinced me that I had spread my oral infection to myself genitally.

Anyway, I feel like I'm getting off topic but all my results came back negative except for HPV. She said the value was 84 and very, very low. She said the swab must of picked up cells from my discharge when she swabbed my anus. I am so confused. My gyno just told me I do not have HPV and that she is not concerned about my ASCUS result because she see's that very often. My gyno said my cervical cells had a slight variation, but they say nothing abnormal. But now my primary doctor is saying I have a very, very low value. 

1. Since I have not been sexually active in 2 years, should I expect the HPV value number to go up and for the virus to reach high grade?
2. Why do my Pap smears state that I do not have HPV?
3. Is this something to be concerned about? 
4. Does everyone have a value number to HPV?
5. Do I in fact have HPV? Can I still have kids?
6. Can you spread your oral hsv 1 infection to yourself genitally, let's say by touching a cold sore and then touching your genitals? My index value has always been above 8.0 for years. 
H. Hunter Handsfield, MD
88 months ago
Welcome to the forum. Thanks for your question. I'll try to help.

Before answering your specific questions, let me provide some perspective. Having HPV is a normal, expected, unavoidable consequence of human sexual activity. Almost everyone gets it at one time or another. Happily, it uncommonly causes serious health problems, and even those are easily and effectively prevented by the things you are already doing, i.e. pap smears and physical examinations to detect pre-cancerous problems before they progress to a point of danger. My general advice to all sexually active persons is to get immunized (if under age 26) to prevent infection with the 9 most problematic HPV types; for women to get regular pap smears; and otherwise forget about it.

In addition to my replies to follow, CDC has excellent information about pap and HPV testing at http://www.cdc.gov/std/hpv/pap/

1,4. HPV test results usually are not numerical, and I don't know how to interpret a result of "84". If you can get more information from your doctor, such as a copy of the actual lab report, I may be able to help interpret it. In any case, the number definitely does not distinguish "high grade" from other virus types.

2,3. Pap smear is a microscopic examination of cells from the cervix or vagina. HPV infected cells have certain kinds of appearance. Your cells apparently do not have that appearance. In other words, even if you have HPV, it is not causing any visible abnormality. That's good news -- i.e. nothing to indicate pre-cancer or any other health problem of concern. You needn't be at all worried.

5. From the information you have provided, I cannot say for sure whether you currently have an active HPV infection. Normally I would say any positive HPV test result is valid, i.e. the virus is present. But not knowing the meaning of the number 84, and your doctor's statement, it seems possible you do not. As for having kids, whether or not you have HPV makes no difference. HPV never prevents healthy pregnancy, delivery, and lovely, healthy children.

6. It is only at this question that I understood you have had positive HSV1 blood test results. Are you certain your current positive test was not another blood test? That is, for sure HSV1 was identified in the swab test from your anal fissure? This would be very unusual, and the vast majority of anal fissures of course are not due to HSV. In any case, HSV sometimes is transmitted from one body area to another (called auto-inoculation), but it occurs almost exclusively with brand new HSV infections. It occurs rarely if ever in people with chronic, longstanding HSV infections. Confirm for sure that the swab test was positive, and preferably whether the test was a viral culture or DNA test like PCR. Don't guess: confirm for sure with your doctor's office. Then I'll be happy to comment further about this aspect.

I hope this has helped. I look forward to your follow-up comments and answers. But please note that each question includes only two follow-up comments and replies -- so gather as much information as you can before we continue.

Best wishes--  HHH, MD

88 months ago
Wow, that put me at ease. Thank you so much for the information.

However, I think you misunderstood me. Hsv was NOT detected from the swab from the anal fissure for hsv 1 or 2, and it was not a blood test. I just know that I have HSV 1 from previous blood tests. Also, I rarely get cold sores underneath my nose. But my doctor freaked me out and said that you can pass your own oral infection to your genitals. I just wanted to know if that's true?
H. Hunter Handsfield, MD
88 months ago
Sorry for the misunderstanding.

Your doctor is mistaken. Like many, he apparently misunderstands some of the nuances of HSV infections. Once someone has had HSV for some time (probably 2-4 months), the immune response to it is quite strong. Even though immunity cannot eradicate latent virus, especially in nerve tissue (where most recurrent outbreaks originate), it is highly protective against new infection with the same virus type -- and certainly reinfection with the same strain. Therefore, couples in which both persons have genital or oral herpes do not "ping pong" their infections back and forth, and need not take precautions against transmission to one another. Autoinoculation is rare for the same reason. That doesn't mean it never happens, but it's rare; and when it does, by far the most common site is the eye, autoinoculated from eye rubbing during an oral herpes outbreak. (You may have been advised to use careful hygiene and frequent hand washing and/or alcohol gel during your facial herpes outbreaks. Protecting the eyes is the main reason. But even this is rare.) Finally, as noted above, HSV is a rare cause of anal fissure, and I would normally not test fissures for HSV. Perhaps your own concerns about HPV and STDs in general led your doctor to test you mostly for reassurance, expecting the negative result that was found.

88 months ago
Thank you Dr. HHH. You, by far, have been the most helpful and provided the most adequate information regarding all of my questions. I cannot thank you enough, and would really like you to know that informative, knowledgable doctors like yourself are hard to find & appreciated when found. 

But yes, the swab test was negative. If it's okay with you, I would like to ask one last question before I go. 

Have you ever seen someone get genital herpes from autoinnoculation? Let's say, from touching a cold sore and then touching their genitals? 

Whenever I get cold sores, I find myself excessively washing my hands because I am so afraid of passing it to other parts of my body. I just wanted to know if this is really something I should be this concerned about.
H. Hunter Handsfield, MD
88 months ago
I'm glad to hear the discussion has been helpful. Thanks for the kind words about our services. Spread the word to others who might benefit.

Almost all persons with both genital and oral herpes due to the same virus type (HSV1 or 2) were infected at both sites simultaneously, i.e. from both oral and genital exposure when they caught the virus. In my 40 years in the STD business, to my knowledge I've never seen anyone with oral herpes who autoinoculated the genital area. As discussed above, attention to hygiene (washing, alchol gel) is a good idea during outbreaks, but probably does little to protect the genital area, only the eyes -- and as I said, even that is uncommon. Excessive hand washing is unnecessary. Do it (or use alcohol gel) whenever you have touched the infected area or think you might have, e.g. after feeling the lesions for pain, applying makeup, etc. Otherwise no worries!

In case you didn't know, oral or facial herpes can be very effectively treated. Ask your doctor for a prescription for a few doses of valacyclovir (Valtrex®) to have on hand. At the first sign of a new outbreak, take 2 grams (two 1 g or four 500 mg tablets) in a single dose. It will prevent the outbreak from continuing, or will speed healing from 7-10 days to 2-5 days.

That concludes the two follow-up replies that come with each new question, and so ends this thread. Take care, stay safe, and try not to worry or obsess over either HPV or your HSV1 infection.